Highmark expands patient-centered medical home initiative

Pittsburgh-based insurer Highmark Inc. announced today that it is expanding its patient-centered medical home initiative, which began in 2011, from 160 primary care doctors to nearly 1,050.

The expanded initiative will affect more than 100 physician practices covering about 171,000 Highmark members in Western and Central Pennsylvania and West Virginia, Highmark said. Through a patient-centered medical home, physicians take greater accountability in coordinating the care for patients.

“In the pilot, we saw a nearly 2 percent reduction in cost, while the rest of the membership actually saw an increase,” Michael Fiaschetti, president of health markets at Highmark, said in a news release.

Other findings from the pilot program:

• Inpatient acute admissions dropped 9 percent on average

• 30-day readmission rate dropped 13 percent on average

• Seven-day readmission rate dropped 14 percent on average

• Total per member per month costs dropped 5 percent for coronary artery disease members and a 3.5 percent for diabetics

Highmark executives said in a conference call that investments the company made to help physicians involved showing them aggregate data on certain classes of patients and what Highmark believed were gaps in their care and, in some cases, putting a nurse in the offices to reach out to chronically ill patients and train members of the office in the new concept.

Changes as small as offices keeping Monday mornings open to see patients who became ill over the weekend helped keep people out of emergency rooms and improved care while decreasing cost, Highmark said.

Dr. Paul Kaplan, senior vice president of provider strategy and integration at Highmark, noted that the health information network and exchange of information between providers is a cornerstone of the change.

Highmark said the model also involves change to the payment system.

“If there are not cost savings, there are not enhanced payments to physicians,” the news release said. “Highmark is focused more on paying for value rather than just paying for the volume of services that have been performed. During the next three years, Highmark hopes to have about 75 percent of members in some kind of pay-for-value arrangement by 2015.”